Add extra cover to your office mediclaim

Group health insurance covers provided by employers are a big source of comfort for millions of employees. Such schemes typically pick up the hospital bills for employees and their family members, their utility being the highest for the employees' elderly parents or in-laws. Most health insurers hesitate while extending covers to senior citizens as the likelihood of individual claims is quite high in this category. Even when they do, the premiums charged are extremely high. Little wonder then that employers' group health covers are treated as a godsend.

However, last year, some insurers decided to impose ceilings on the benefits in order to control mounting losses in their portfolios. In most cases, this was done by introducing the co-pay clause. A few organisations completely excluded the cover for parents, while others transferred the cost (premium for parents' covers) to employees.

"Last year, some companies had capped the benefits provided to employees in terms of parental coverage and this trend continues this year as well," says Sanjay Datta, head, health insurance, ICICI Lombard. Adds Damien Marmion, CEO, Max Bupa: "Organisations are looking at managing their costs better. One way to do this is to maintain the same costs but revise their service offering. Limiting the coverage to just the employee, introducing co-pay, etc, are some of the changes that are being made." Some companies are also offering employees the option of paying an additional premium for extending the cover to their families or increasing the cover amount.

"As the claim ratios have been unhealthy in the parents' segment, insurers have either hiked the premium by 30-100% or added new restrictions, such as co-pay, deductibles, treatment sub-limits and so on," says Mahavir Chopra, head, e-business, medimanage.com, an insurance broking portal. The changed scenario means that whether your organisation tightens its belt or not, you need to be prepared for the possibility that your parents could be left out of the group cover.

SITUATION 1

If parental cover is scrapped: It could be a major setback, but companies seldom take such a drastic measure. In any case, you will be better off reducing your reliance on your company's largesse. "Employees should stop depending only on the employer-enabled parental coverage and start evaluating a good health insurance product, preferably offering a lifetime coverage. As parents get older, the chances of getting a good health plan with wider coverage decreases substantially," says Chopra. If your parents are above 60 years, you could look at senior citizen health policies offered by health insurers. Opt for the largest possible cover.

SITUATION 2

Cover comes with the co-pay clause: Co-pay clause refers to the arrangement where the policyholder (in this case, the employee) agrees to share the claim burden in a pre-defined proportion, with the insurer chipping in with the balance. Co-pay ratios usually range between 10% and 25%. So, for every claim of Rs 100 made, the policyholder will have to shell out Rs 25 (assuming 25% to be the co-pay ratio), while the insurance company foots the bill for Rs 75.

Your plan of action in this case would depend on the terms of the scheme offered by your employer. If the benefits under such plans, particularly the pre-existing disease cover, are not offered by other individual health policies in the market, you can consider giving your assent to this arrangement.

"If the policyholder feels that the group cover is insufficient, he can opt for a top-up cover," says Datta. Such covers are triggered only after the limit under the basic policy is breached. Suppose your company covers your parents to the extent of Rs 2 lakh, which you feel is inadequate. You can buy a top-up policy of Rs 1 lakh, which will become effective only if the entire cover of Rs 2 lakh is exhausted. Going for a top-up will be a cheaper option than buying a regular policy.

To further boost the health cover, you can consider buying benefit policies for your parents. Offered mainly by life insurers, such policies hand out a pre-fixed sum once the claim is made. Some policies also provide a pre-decided amount based on the number of days spent in the hospital. The claim approval process is relatively smooth and does not entail submission of original bills and documents. You can make a claim under such policies even if you have been reimbursed by the corporate cover.

SITUATION 3

The company provides parental cover, but you have to bear the premium cost: The terms of the group cover would be important here too. Often, health insurers are more generous while dealing with corporate mediclaim policyholders. They get preferential treatment as insurers try to ensure that the service offered to this category is satisfactory.